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One difference I’ve noted between Americans and Europeans (especially the British) is the attitude towards quality of care. Many more Americans expect the “best

by nugget 8y ago

One difference I’ve noted between Americans and Europeans (especially the British) is the attitude towards quality of care. Many more Americans expect the “best” care; it’s almost encoded in DNA, like a byproduct of their fiercely independent historical nature. By contrast, the British are more communal and expect the same care that the vast majority of their fellow citizens receive. It doesn’t seem to bother the British that a small % of wealthy people can purchase better care in a mirrored private insurance system. If the American health care system is restructured and the result is 70% universal medicare and 30% supplemental private insurance or fee for service (with better quality providers, expanded diagnostic services, and shorter wait times), is that a real leap forward or will there simply be a different set of political problems created?

deogeo 8y ago
> is that a real leap forward or will there simply be a different set of political problems created? The question you should be asking is, will fewer people die of preventable medical causes.
- nugget 8y ago
  That’s a very commendable metric to use but there’s very little political support for it. If Medicare banned hip replacements for anyone older than 75 and reallocated those resources to preventative care, many more “years” of life would likely be saved. (Not to mention heroic end of life care in hospital ICUs which Americans seem to culturally celebrate.) But you would start to see backlash from families affected. My point is simply that you couldn’t import the NHS to America and expect it to function well; there are unique social, cultural, and political considerations that have to be factored into a reform of the system.
  - akiselev 8y ago
    How'd you go from "will fewer people die of preventable medical causes" to "[i]f Medicare banned hip replacements for anyone older than 75"? To your specific example, immobility is a significant contributing factor for most age related conditions and a hip replacement is an expensive but efficient preventative treatment in old age, especially when it enables the patient to return to regular exercise. Hip replacements aren't like organ transplants where there are a limited number to go around that present an unavoidable moral dilemma. Such a ban would be political suicide for anyone who even proposes it since seniors vote much more reliably so I don't think anyone expects to ship the NHS bureaucracy here wholesale.
  - metildaa 8y ago
    ICU heroics isn't anywhere near as revered as our media makes it out to be. If it were, hospice and death with dignity (in some states like my own) would not be offered. Most dying people I've seen choose to live the best quality of life they can rather than attempt to extend their lifespan with procedures that likely will not help. https://www.deathwithdignity.org/news/2018/12/impact-of-death-with-dignity-on-healthcare/ https://www.deathwithdignity.org/news/2018/12/impact-of-deat...
jellicle 8y ago
There's a major PR effort behind American care exceptionalism, though by any statistic you care to measure, US citizens get very poor care compared to any other first-world nation.
- metildaa 8y ago
  If you exclude the middle and lower classes, Americans get better than average care. Thing is, that is 90% of the population which isn't getting quality care.
klenwell 8y ago
There was an NPR interview with a director or journalist with the Kaiser Family Foundation in which she addressed this in a slightly different way that presented a variation on this theme to me. She said when you go to a hospital or medical office in Europe they generally look like an American junior high school. When you go to a hospital in the US, they often look like a resort hotel, especially the new ones. Such amenities are unrelated (or even counter-indicative) to the quality of medical care provided. The average European receives better care on average. This also resonates with one area of my own medical care experience here in America: dentistry. My current dentist operates out of a modest office in an old strip mall in an unglamorous part of town. No fancy monitors hovering over every dental chair. No efforts to upsell me on cosmetics or prescriptions every visit. Just solid reliable affordable dental care. I recognized in retrospect an anxious subtle almost subliminal feeling I would get whenever I walked into most dental offices before finding my current dentist. All these fancy state-of-the-art amenities, the giant saltwater aquarium, who knows how much in loans to pay off for a newly graduated dentist: somebody's gotta pay for these niceties somehow. I wouldn't be surprised to find out the majority of patients were, unfortunately, impressed and reassured by such superfluities.
- AlexandrB 8y ago
  I agree wholeheartedly. I've been in several Canadian hospitals, and the older ones tend to feel cramped and have old fixtures, chairs, etc. Like a school built in the 70s. However in all cases I - or my loved ones - received what I would consider excellent care. This resembles the "crisis" in education, where Univesities are spending huge sums of money from rising tuition fees on fancy facilities and amenities even as full professors are replaced with adjuncts.

by nugget 8y ago

deogeo 8y ago

> is that a real leap forward or will there simply be a different set of political problems created? The question you should be asking is, will fewer people die of preventable medical causes.

nugget 8y ago
That’s a very commendable metric to use but there’s very little political support for it. If Medicare banned hip replacements for anyone older than 75 and reallocated those resources to preventative care, many more “years” of life would likely be saved. (Not to mention heroic end of life care in hospital ICUs which Americans seem to culturally celebrate.) But you would start to see backlash from families affected. My point is simply that you couldn’t import the NHS to America and expect it to function well; there are unique social, cultural, and political considerations that have to be factored into a reform of the system.
- akiselev 8y ago
  How'd you go from "will fewer people die of preventable medical causes" to "[i]f Medicare banned hip replacements for anyone older than 75"? To your specific example, immobility is a significant contributing factor for most age related conditions and a hip replacement is an expensive but efficient preventative treatment in old age, especially when it enables the patient to return to regular exercise. Hip replacements aren't like organ transplants where there are a limited number to go around that present an unavoidable moral dilemma. Such a ban would be political suicide for anyone who even proposes it since seniors vote much more reliably so I don't think anyone expects to ship the NHS bureaucracy here wholesale.
- metildaa 8y ago
  ICU heroics isn't anywhere near as revered as our media makes it out to be. If it were, hospice and death with dignity (in some states like my own) would not be offered. Most dying people I've seen choose to live the best quality of life they can rather than attempt to extend their lifespan with procedures that likely will not help. https://www.deathwithdignity.org/news/2018/12/impact-of-death-with-dignity-on-healthcare/ https://www.deathwithdignity.org/news/2018/12/impact-of-deat...

jellicle 8y ago

There's a major PR effort behind American care exceptionalism, though by any statistic you care to measure, US citizens get very poor care compared to any other first-world nation.

metildaa 8y ago
If you exclude the middle and lower classes, Americans get better than average care. Thing is, that is 90% of the population which isn't getting quality care.

klenwell 8y ago

There was an NPR interview with a director or journalist with the Kaiser Family Foundation in which she addressed this in a slightly different way that presented a variation on this theme to me. She said when you go to a hospital or medical office in Europe they generally look like an American junior high school. When you go to a hospital in the US, they often look like a resort hotel, especially the new ones. Such amenities are unrelated (or even counter-indicative) to the quality of medical care provided. The average European receives better care on average. This also resonates with one area of my own medical care experience here in America: dentistry. My current dentist operates out of a modest office in an old strip mall in an unglamorous part of town. No fancy monitors hovering over every dental chair. No efforts to upsell me on cosmetics or prescriptions every visit. Just solid reliable affordable dental care. I recognized in retrospect an anxious subtle almost subliminal feeling I would get whenever I walked into most dental offices before finding my current dentist. All these fancy state-of-the-art amenities, the giant saltwater aquarium, who knows how much in loans to pay off for a newly graduated dentist: somebody's gotta pay for these niceties somehow. I wouldn't be surprised to find out the majority of patients were, unfortunately, impressed and reassured by such superfluities.

AlexandrB 8y ago
I agree wholeheartedly. I've been in several Canadian hospitals, and the older ones tend to feel cramped and have old fixtures, chairs, etc. Like a school built in the 70s. However in all cases I - or my loved ones - received what I would consider excellent care. This resembles the "crisis" in education, where Univesities are spending huge sums of money from rising tuition fees on fancy facilities and amenities even as full professors are replaced with adjuncts.